Common use of Claim Review Clause in Contracts

Claim Review. a. The CONTRACTOR must perform a claim review when a PARTICIPANT requests a review of denied BENEFITS. When a claim review has been completed, the CONTRACTOR must notify the PARTICIPANT of the decision. b. If the decision is to uphold the denial of BENEFITS, the CONTRACTOR must provide the PARTICIPANT written notification as to the specific reason(s) for the continued denial of BENEFITS and of their right to file a grievance.